Florida Investigating Massive Fraud in Dade County

State investigators are considering criminal charges after finding regulatory violations in almost 90 percent of the pain clinics that treat automobile accident victims in Miami-Dade County.

A report by the Agency for Health Care Administration revealed irregularities were discovered during a recent three-day sweep by investigators in 43 of 49 Miami-Dade County clinics. In one case, an insurance company providing personal injury protection coverage, also known as PIP, was charged $19,000 for massage therapy.

During those checks, investigators witnessed only 17 patients while employees at some clinics reported they had never seen a patient. At one clinic, staff said they had not seen the owner or medical director in six months.

Spokeswoman Shelisha Coleman said the report will prompt the agency to take action to revoke the licenses of several entities and criminal charges may be filed. While the agency’s investigation is wrapping up, the state’s Division of Insurance Fraud is continuing the probe.

Florida lawmakers, who have struggled unsuccessfully for years in their attempts to fix PIP, are being challenged by Republican Gov. Rick Scott to find a solution in the session that begins Tuesday. Some of the ideas that have been discussed range from providing emergency care only within three days of an accident to doing away with the program entirely.

The investigation found that most of the Dade County clinics treated auto accident victims exclusively and that the primary treatment billed by them was for massage therapy. Investigators also found that many clinic owners had no prior health care experience and reported they opened auto crash clinics after learning they could be a lucrative business venture.

Many clinics also displayed advertisements for law firms and attorneys who specialized in traffic accident litigation while in numerous instances medical professionals at the clinics were employed without the required background screening. And one man kept his job despite being deemed ineligible on his background check.

PIP was adopted in 1972 to make sure anyone injured in an auto accident would quickly get money to treat their injuries. The legislation provided that a driver’s insurance company pay up to $10,000 to cover medical bills and lost wages after an accident, no matter who is at fault.

Schemers have turned Florida into the No. 1 state for staged accidents, particularly in the metropolitan Miami and Tampa areas. Lawmakers heard testimony last year that it has become so lucrative that organized crime has gotten involved.

All Florida drivers are required to carry no fault insurance.

The Insurance Information Institute predicts that such fraud could approach $1 billion in the state this year – costs that are passed on to customers.